Peripheral Vascular Disease Procedures
About Peripheral Vascular Disease (PVD)
What is PVD?
Peripheral vascular disease is a common circulation
problem in which the arteries that carry blood to the legs or arms
become narrowed or clogged. This interferes with the normal flow
of blood, sometimes causing pain, but often causing no symptoms at all.
The most common cause of PVD is atherosclerosis, often called "hardening
of the arteries." Atherosclerosis is a gradual process in which
cholesterol and scar tissue build up, forming a substance called plaque
that clogs the blood vessels. In some cases, PVD may be caused by blood
clots that lodge in the arteries and restrict blood flow. Left
untreated, this insufficient blood flow can ultimately lead to limb
amputation in some patients.
In patients suffering from atherosclerosis, the blood flow channel
narrows from the buildup of plaque, preventing blood from passing
through as needed and restricting the amount of oxygen and other
nutrients that reaches normal tissue. The arteries also become rigid and
less elastic, which hinders their ability to react to tissue demands
for changes in blood flow. Many of the risk factors of atherosclerosis -
high cholesterol, high blood pressure, smoking, and diabetes - may also
damage the blood vessel wall, making the blood vessel prone to diffuse
The most common symptom of PVD is called claudication, which is leg
pain that occurs when walking or exercising and disappears when the
person stops the activity. Other symptoms include numbness, tingling, or
coldness in the lower legs and feet and ulcers or sores on the
legs or feet that don't heal. Many people simply live with their pain,
assuming it is a normal part of aging rather than reporting it to a
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Angiography - Minimally Invasive Surgical Solutions and Angiogram
are performed by interventional radiologists (IR). Angiography is an
X-ray exam of the arteries and veins to diagnose blockages and other
blood vessel problems. During an angiogram, the doctor inserts a thin
tube (catheter) into the artery through a small nick in the skin about
the size of the tip of a pencil. A substance called a contrast agent
(X-ray dye) is injected to make the blood vessels visible on the X-ray.
In many cases, a IR can treat a blocked blood vessel without surgery
at the same time the angiogram is performed. Interventional radiologists
treat blockages with techniques called angioplasty and thrombolysis.
People with risk factors or any signs or symptoms of vascular
disease, should be evaluated by a physician. Untreated vascular disease
can lead to serious health problems, such as tissue death and gangrene
requiring amputation or other surgery, chronic disability and pain, and
weakened blood vessels that may rupture without warning. Deadly
complications can result, including stroke (a clogged or narrowed blood vessel cuts the supply of blood to the brain) and pulmonary embolism (a blood clot breaks loose and travels to the heart and lungs).
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Angioplasty and Stent Placement - Minimally Invasive Surgical Solutions; Angioplasty and Stent Placement
is a technique used by interventional radiologists to treat blocked
blood vessels. The IR inserts a very small balloon attached to a thin
tube (catheter) into a blood vessel through a small nick in the skin.
The catheter is threaded under X-ray guidance to the site of the blocked
artery. The balloon is then inflated to open the artery.
Sometimes, a small metal scaffold tube, called a stent, is inserted to
hold the blood vessel open. In many cases, interventional radiologists
can open blocked or narrowed blood vessels caused by peripheral arterial
disease or other
conditions. For example, in some patients, high
blood pressure is caused by blockage to the artery to the kidney, a
condition known as Renal Vascular Hypertension.
radiologists can often treat blocked blood vessels without surgery. In
most cases, hospitalization and general anesthesia are not
required. There is no surgical incision, just a small nick in the
skin and no stitches are needed. Often, patients may return to normal
activity shortly after the procedure.
Between 70 percent and 90
percent of the angioplasty procedures use a stent. A stent is a hollow,
thin-walled wire mesh tube which keeps the vessel open after widening
it. Because arteriosclerosis, or hardening of the arteries due to a
build-up of cholesterol and scar tissue, is an ongoing disease,
more plaque might form and again limit blood flow. The stent is placed
onto the balloon and pressed firmly against the artery wall when
inflating it. The balloon then is deflated, leaving the stent in place
to act as a scaffold.
Occasionally the plaque will not
remain against the inner lining of the artery but goes back to its
former position after the balloon is deflated. Another possibility is
that a small amount of plaque may continue to block the flow of blood.
In these cases the radiologist may place a stent that is expanded at the
site of plaque.
The muscle tissue in the vessel wall
holds the stent in place. In time, a layer of cells forms over the
stent, which in effect becomes a part of the vessel. In some cases, the
size of the diseased artery and the site of blockage make a stent
especially useful. A stent also may be placed to keep an artery
open if the inflated balloon has torn or damaged it. Some modern stents
are covered with a drug that helps keep the artery open; they seem to
improve the long-term success rate.
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Aortic Aneurysms - Minimally Invasive Surgical Solutions and Abdominal Aortic Aneurysm (AAA)
abdominal aortic aneurysm (AAA) is a weak area in the wall of the
abdominal aorta, the artery that carries blood from the heart to the
rest of the body. The aorta is the body's largest blood vessel. When an
area is weak, it may bulge like a balloon when blood flows through it.
The most common site for an aortic aneurysm to occur is below where the
aorta divides to supply blood to the kidneys and above where it divides
to supply blood to the pelvis and legs. An aneurysm that occurs in this
location is called an abdominal aortic aneurysm (AAA).
Treatment of an abdominal aortic aneurysm may require
surgery. For some patients, however, a new, non-surgical treatment
called "stent-graft repair" can be performed by an interventional
radiologist. Once an aneurysm has been diagnosed, the treatment will
depend on a number of factors, such as the size of the aneurysm and the
overall health of the patient. A small aneurysm may require no immediate
treatment other than "watchful waiting" - checking the aneurysm
regularly to be certain it does not grow. The normal diameter of the
aorta is about 1 inch or less. Small aneurysms of less than 2 inches (5
centimeters) in diameter rarely rupture and may pose little risk. If an
aneurysm reaches a certain size, however, there is a danger that it will
burst and bleed uncontrollably (hemorrhage). In these cases treatment
is necessary. If the aneurysm is small but there are symptoms,
treatment may be required to prevent complications. Medication may be
prescribed to lower blood pressure or to relieve pain. If the aneurysm
grows to 5.5 centimeters or larger, however, physicians usually
recommend treating them with surgery or with non-surgical stent-graft
Stent Graft Repair
In this minimally invasive technique, an interventional radiologist
uses imaging to guide a catheter and graft inside the patient's artery.
For the procedure, an incision is made in the skin at the groin through
which catheter is passed into the femoral artery and directed to
the aortic aneurysm. Through the catheter, the physician passes a stent
graft that is compressed into a small diameter within the catheter. The
stent graft is advanced to the aneurysm and then opened, creating new
walls in the afflicted blood vessel.
This is a less invasive method of placing a graft within the aneurysm
to redirect blood flow and stop direct pressure from being exxerted on
the weak aortic wall. This relatively new eliminates the need for a
large abdominal incision. It also eliminates the need to clamp the aorta
during the procedure, as is done in the open surgical procedure.
Clamping the aorta creates significant stress on the hear, and people
with severe heart disease may not be able to tolerate this major
surgery. Stent grafts are most commonly considered for patients at
increased surgical risk due to age or other medical conditions.
The stent graft procedure is not for everyone, though. It is still a
new technology, and we don't yet have data to show that this will be a
durable repair for long years. Thus, people with a life expectancy of 20
or more years may be counseled against this therapy. It is also a
technology that is limited by size. The stent grafts are made in certain
sizes, and the patient's anatomy must fit the graft, since grafts are
not custom-built for each patient's anatomy.
A stent-graft is threaded into the
blood vessel where the aneurysm is located. The stent graft is expanded
like a spring to hold tightly against the wall of the blood vessel and
cut off the blood supply to the aneurysm.
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